Normal-Weight Teens Can Have Eating Disorders

Researchers saw a nearly 6-fold rise in patients who met all criteria of anorexia except being underweight

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"In fact, we miss a lot of eating disorders when focusing primarily on weight," Bulik added.

Leslie Sim, an assistant professor of psychology at Mayo Clinic Children's Center in Rochester, Minn., said, "People are calling it atypical anorexia, but we see it every day. We see people who have all the psychological, behavioral, cognitive and physical symptoms of anorexia nervosa, but the only difference is their weight."

In this study, the side effects of having an eating disorder were also very similar. Dangerously low phosphate levels occurred in 41 percent of anorexia patients and 39 percent of EDNOS-Wt patients. The lowest pulse for the teens was 45 beats per minute (bpm) for those with anorexia and 47 bpm for the other group. Meanwhile, 38 percent of the EDNOS-Wt patients and 30 percent of the anorexia patients required tube feeding.

"[Normal-weight patients with anorexia symptoms] were becoming medically unstable, despite the fact that they had what you would call a normal body weight," Whitelaw said.

The reasons for the apparent increase in these patients is less clear, but both Sim and Whitelaw said it is likely a combination of increased awareness of the problem and an increased focus on obesity. One tricky aspect of identifying these patients, Sim said, is that the weight loss appears at first to be a positive development.

"These patients just fly under the radar and when they're in that earlier stage, it's harder for people to see it," Sim said. "Parents say to me every day, 'I thought my daughter was doing something good and making healthy choices until it got out of control. We didn't know it was a problem until she couldn't eat the cake at her birthday party.' "

The experts emphasized that eating disorders are not parents' fault. Instead, parents can play an important role in identifying the symptoms of an eating disorder, especially in its early stages, said Jessica Feldman, a licensed social worker and site director of The Renfrew Center in Radnor, Pa. Symptoms include significant changes in eating patterns, excessive exercising, a teen's negative statements about their body image, an increase in depression or anxiety, and a loss of interest in previously enjoyable activities.